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13 Neurological condition in Children - Coggle Diagram
13 Neurological condition in Children
Febrile Seizures热性惊厥
Medical treatment
Seizure control: rectal Diazepam STAT
Fever control
antipyretics drugs (paracetamol)
cooling measure (removing heavy blankets & clothing)
NO TEPID SPONGING
:the shivering effect increases metabolic output, cooling causes discomfort
Nursing Management
DURING SEIZURE
Observe & document the stages & clinical manifestations
Ensure safety
no hard/ sharp objects around
padded bed rails
DO NOT
attempt to put objects into the child's mouth
no feeding of medication orally during fits & when the child is still drowsy
Maintain patent airway
place the child on the side to prevent choking of secretions
perform suctioning
loosen up clothing
POST SEIZURES
Fever management
administrate medication prescribed by doctor
cool the child by removing the blanket / thin clothing
Maintain nutrition & hydration status
Parental education & emotional support
Clinical Manifestations
involuntary jerking on arms & legs, up-rolling of the eyes, teeth clenching, drooling流口水/ pooling of secretions, uncontrolled urine/ bowel movement, tired/ sleepy post seizures
Patient education
ALWAYS BRING CHILD TO THE DR. IF:
the seizure lasts more than 15 minutes
the child is unable to move one side of his body, (arms/legs) after the seizure
the child is unusually irritable/ drowsy after the seizure
the child sustained injury during the seizure (e.g. head injury as result of falling)
Def: Generalized seizures occurring in children as a result of a
rapid rise in temperature >38.8°C
- transient condition of abnormal electrical discharges in the brain will cause
involuntary movement, behavior & sensory alterations
Head Injury
Clinical manifestations
headache, irritability, drowsiness, blurred vision, vomiting, altered mental state, seizure, unconsciousness, decerebrate posture, decorticate posture
decerebrate (extensor)
decorticate (flexor)
Diagnostic evaluations
detail history about the injury
through physical examination (assessment on level of consciousness & neurological status)
x-ray (skull, abdomen, pelvis, chest, spine)
CT brain/ MRI brain
EEG (electroencephalogram)
Blood for Arterial Blood Gas (ABG) / Capillary Blood Gas (CBG) analysis
Causes
Toddlers & pre-schoolers
fall from height, hard object falling on the head/ hits on head by hard object
Older children
automobile accidents/ road-traffic accidents, sports & recreation injury, fall from height, penetrating injury through eyes, crush injury, fall of heavy objects on head
Neonates
birth injury/ instrumental delivery, shaken baby syndrome
Pathophysiology
brain injury is directly related to the force of impact
primary head injuries occurs at the time of trauma: skull fractures, contusions, intracranial hemorrhage/ hematoma, diffuse injury
subsequent complications include: increased ICP, cerebral edema, hypoxic brain damage, infection
hypoxia & hypercapnea increased energy requirement for the brain which in turn increased cerebral blood flow
exacerbation of cerebral edema will increased intracranial pressure (ICP)
increased ICP pressure more than arterial pressure will result in inadequate perfusion
decreased blood flow to the brain may lead to brain damage/ death
Nursing Management
Monitor vital signs (BP, HR, RR), neurological signs & LOC (Level of consciousness) (GCS)
check the pupils for size, equality, reaction to light
observe the position & movement
identify the signs of increased ICP
Complete bed rest with the head of bed elevated, the head in midline position
Seizures precaution
keep side rails up
pad bed rails
record & document seizure event
Provide analgesia: to promote comfort
Wound care if necessary
Document drainage from any orifice
bleeding from ear: basal skull fracture
clear nasal drainage: anterior basal skull fracture
Keep quiet & dimmed environment: to reduce irritability
Monitor I/O: to look out for diabetes insipidus尿崩症
Provide IV infusion if child is NBM due to altered mental status: ensure adequate hydration
Provide clear fluid if the child is with normal IDC
Observe for any incontinence of bladder/ bowel if the child is toilet trained: changes in elimination status suggest deterioration in brain function
Prevent infection
def: an injury involving the scalp, skull, meninges/ any portion of the brain caused by an external force.
Nursing diagnosis
Risk for
IMPAIRED SKIN INTEGRITY
related to physical immobility/ fall/ trauma
Inspect all skin surfaces, noting areas of erythema/ edema. Pay particular attention to all bony prominences in direct contact with the bed.
(R) Lying in one position for extended periods, increases the risk of tissue breakdown & decubitus formation.
Reposition every 2 hours. Place child in prone position periodically (unless contraindicated by medical condition)
(R) Repositioning helps to improve circulation & relieves pressure areas.
Sponge child daily & keep bedding free of wrinkles.
(R) Bathing increases circulation because of the massaging of the skin with the washcloth. Having a bed free of wrinkles, can prevent skin breakdown & pressure ulcers
COMPROMISED FAMILY COPING
related to loss of well-being of child
Assess level of anxiety/ concern of parent/ family members.
(R) Provide data to determine type of assistance/ support that is needed.
Provide opportunities for instruction on how to care for the ill child.
(R) Enhances feelings of control & involvement in the health care of the child.
Reinforce/ clarify medical explanation of child's condition & prognosis.
(R) ensures parents & family have a clear understanding of information received.
Provide support groups to the family.
(R) Provides family with sources of emotional & spiritual support in time of crisis.
INEFFECTIVE AIRWAY CLEARANCE
(inability to clear his secretion)/
INEFFECTIVE BREATHING PATTERN
related to decreased level of consciousness
Observe airway for patency.
(R) diminished oxygenation can lead to cerebral anoxia & death
Observe for presence/ absence of swallow reflex, respiration rhythm, & effort; note any irregularities.
(R) A marked increase/ decrease in respiratory pattern can be a sign of impending respiratory failure
Auscultate breath sounds, noting & reporting any adventitious breath sounds (crackles/ wheezes).
(R) indicative of accumulated respiratory secreations, may increase the risk for pneumonia or atelectasis.
Provide meticulous suctioning to prevent respiratory compromise.
(R) suctioning of oral secretions, cleaning of buccal cavity, and turning child every 2 hours will help to prevent respiratory problem.